An all too familiar scenario is occurring in labor and delivery units across the country: increasing cesarean delivery rates and increasing elective induction rates create patient flow problems, bed shortages and care concerns.  The challenge for our organization was to respond to this patient flow crisis in a physical environment not prepared to handle increasing volume.  A multidisciplinary team was formed to examine the barriers to efficient scheduling of cesarean deliveries to maximize utilization of available OR space and improve on time deliveries to improve overall satisfaction.  Several improvements were made but a persistent barrier identified was the impact a non-criteria based labor induction had on overall patient flow in the department.  Failed inductions leading to unscheduled cesarean deliveries regularly caused delays in the scheduled procedures. Again, a multidisiciplinary team examined the quality and efficiency data and implemented and enforced criteria-based induction scheduling.  The results of these scheduling improvements included great improvement in on-time surgeries, drastic reductions in elective inductions that do not meet ACOG criteria, a near elimination of NICU admissions as a result of an elective induction and a reduction in primary cesareans following induction. Additionally, the department has been able to absorb increasing volume and demonstrate efficient utilization of available operating room space.